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PWE-394 Are we misdiagnosing foreign body reaction to biologic implants as mesh-related infection?
  1. S Zeidan,
  2. D Cruttenden-Wood,
  3. D Tarver,
  4. A Clarke,
  5. M Ahmad
  1. Poole Pelvic Floor Unit, 2Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, UK

Abstract

Introduction Concern regarding mesh erosion has led to the increased use of biological implants in laparoscopic ventral rectopexy (LVR). There is a growing recognition that biological implants are not inert and their introduction into the body triggers a sequence of events leading to the formation of foreign body giant cells at the tissue/implant interface. This could lead to systemic inflammatory response syndrome (SIRS) that mimics mesh-related infection.

Method The records of 4 patients readmitted after LVR were assessed retrospectively. A radiologist with an interest in pelvic floor surgery reviewed their CT scans.

Results We performed 27 LVRs from October 2013–2014 using Biodesign ® biological implant and 19 using synthetic mesh. 4 patients (15%) from the biologic cohort were re-admitted with pain and pyrexia and a pelvic abscess was suspected. CRP was raised in 4 (mean 276 at readmission and 99 at discharge) but in only one was the WCC elevated. All 4 received antibiotics and 2 patients had percutaneous drainage of sterile collections while the other two had no intervention. Those treated with drainage had a longer hospital stay and a delayed recovery compared with the observation only group. All made a complete recovery and none had either symptoms of their original prolapse or dysfunctional defecation. None of the patients in the synthetic mesh group were readmitted.

Conclusion SIRS is a natural reaction to the implantation of non-inert foreign material as evidenced by elevated inflammatory mediators in the absence of a neutrophilia. This small study would suggest that the drainage of such 'collections' following insertion of biological meshes is not only unnecessary but may run the risk of introducing sepsis into a sterile environment. The routine use of intravenous antibiotics might be unnecessary and a watchful waiting approach should be considered.

Disclosure of interest None Declared.

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